[The results of the surveys of the Lung Cancer Task Force of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR)].

BACKGROUND

After its formation in 1991, the Lung Cancer Task Force of the Spanish Pneumology and Thoracic Surgery Society (SEPAR) wrote a list of Spanish research priorities as a basis for future multi-center studies.

OBJECTIVES

1. To obtain information on ways of diagnosing, treating and making decisions regarding patients with bronchogenic carcinoma; 2) to identify different attitudes toward bronchogenic carcinoma with homolateral mediastinal adenopathy (N2); 3) to sound out thoracic surgeons regarding their participation in nationwide collaborative studies on bronchogenic T3 and T4 carcinoma and obtain their views on concrete surgical questions; and 4) to study protocols for postoperative surveillance.

MATERIAL AND METHODS

The Executive Committee took into consideration the contributions of Task Force members in writing four survey questionnaires. Survey 1: "Ways of studying, treating and coming to decisions about patients with bronchogenic carcinoma." Survey II: "Diagnostic and therapeutic attitudes toward N2." Survey III: "Bronchogenic T3-T4 carcinoma." Survey IV: Postoperative assessment in bronchogenic carcinoma." Forty-seven, 43, 35 and 42 replies, respectively, were received. Analysis of evaluable replies provide the basis of the results.

RESULTS

Survey I: The 47 replies came from 32 hospitals; 21 also sent copies of their diagnostic-therapeutic protocols, revealing 19 different models for clinical use (17) or research (2). SURVEY II: X-rays and computed tomography (CT) of the thorax are the non-invasive procedures used by most of the respondents (39 or 95%). Mediastinoscopy is indicated selectively according to 32 (78%) and routinely according to 7 (17%). Twenty-eight (68%) respondents confirm N2 X-rays histologically and 9 (22%) resort immediately to surgery. Five (12%) exclude from surgery any N1 found by mediastinoscopy or mediastinotomy, while the others may exclude such patients depending on histological type, number and location of ganglia and type of mediastinal involvement. After induction chemotherapy in patients excluded from surgery, 24 (59%) may restore eligibility if some form of remission is observed. If N2 is found during thoracotomy, 25 respondents (61%) follow with pulmonary resection and mediastinal lymphadenectomy, although they first take into account mainly patient operability, likelihood of a complete resection, tissue type, invasion of the gangliar capsule and the number of malignant nodes found. SURVEY III: Twenty-seven, or a 98% majority of the 29 evaluable respondents, said that they would be in favor of a national register of T3-T4 carcinoma, would use a computerized system for recording case histories and would follow a standard therapeutic protocol. All believe that resection of the pleura and the costal wall and intercostal space is useful; slightly more than half believe that it would be useful to extend resection to the trachea and carina, superior vena cava or atrium. Eight (30%), 11 (41%) and 12 (44%) favor resection of the vertebral body, muscle wall of the esophagus and the pulmonary artery, respectively. Twenty-four (83%) place no faith in partial surgery in cases of T3 and T4. SURVEY IV: Thirty (96%) of the 31 thoracic surgeons who answered the questionnaire follow their patients after surgery, while only 7 (63%) of the 11 pneumologists do so. Thirty-four (80%) use a postoperative follow-up protocol and 29 (69%) note the tumor-free interval. Twenty-three (54%) make a functional assessment of the patient and 26 (62%) order blood and biochemical work-ups. There is little agreement on the use of tumoral markers and only 6 (14%) do immunological studies occasionally. All use simple chest X-rays routinely; CT, abdominal sonograms and bone gammagrams may be used, depending on clinical data and physical examination. Most (36 or 85%) believe that collaboration on a postoperative protocol for nationwide use would be useful. (ABSTRACT TRUNCATED)